Federal Medicaid Expansion Under Fire

Yesterday’s Washington Post ran an article that highlights an interesting twist on the upcoming Supreme Court’s review of the federal health care reform’s insurance mandate.  Supreme Court justices have also decided to review the law’s provision to broaden Medicaid eligibility to approximately 17 million new individuals.

And, according to a November 14 article in Slate entitled The Medicaid Ambush, The Supreme Court’s actions on the Medicaid expansion “… could cripple the federal government’s capacity to promote national policy goals more gravely than even a decision to overturn the ACA individual mandate…”.  You can view the article here.

Under the Affordable Care Act (ACA), states must cover all persons with incomes up to 133% of the federal poverty level beginning in 2014.  The federal government will completely fund this expansion until 2020, when federal support decreases to 90%.  The challenge comes from 26 states who claim that this section of the ACA unconstitutionally coerces state governments.  In essence, with 100% of federal financial backing, states have little option but to accept the expansion.  Or, according to Slate, “The Medicaid expansion is too good a deal for the states to turn down.”

Patient advocacy groups are concerned by the potential fallout from the Supreme Court review.  But it is possible their concerns will be redressed in court, as every lower court that has reviewed the Medicaid expansion complaint has rejected it.  Additionally, no federal court has ever accepted the argument that a state has been unconstitutionally coerced as a result of accepting federal dollars with requirements attached.

The Supreme Court will begin to hear oral arguments at the end of March or beginning of April, 2012 and will likely render a final decision at the end of June, 2012.

-Jaime Venditti, 11/18/11